Janani Thillainadesan1, Sarah J Aitken2, Sue R Monaro3, John S Cullen4, Richard Kerdic5, Sarah N Hilmer6, Vasi Naganathan4. 1. Department of Geriatric Medicine, Concord Hospital, Concord, Sydney, Australia; Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, Sydney, Australia; Center for Education and Research on Aging, and Aging and Alzheimers Institute, Concord, Sydney, Australia. Electronic address: Janani.Thillainadesan@health.nsw.gov.au. 2. Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, Sydney, Australia; Concord Institute of Academic Surgery, Vascular Surgery Department, Concord Hospital, Concord, Sydney, Australia; Department of Vascular Surgery, Concord Hospital, Concord, Sydney, Australia. 3. Department of Vascular Surgery, Concord Hospital, Concord, Sydney, Australia; Susan Wakil School of Nursing, The University of Sydney, Sydney, Australia. 4. Department of Geriatric Medicine, Concord Hospital, Concord, Sydney, Australia; Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Concord, Sydney, Australia; Center for Education and Research on Aging, and Aging and Alzheimers Institute, Concord, Sydney, Australia. 5. Department of Vascular Surgery, Concord Hospital, Concord, Sydney, Australia. 6. Kolling Institute of Medical Research, Sydney Medical School, University of Sydney and Royal North Shore Hospital, St Leonards, Sydney, Australia.
Abstract
OBJECTIVE: This study evaluates the impact of a novel model of care called Geriatric Comanagement of Older Vascular surgery inpatients on clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS: A pre-post study of geriatric comanagement, comparing prospectively recruited preintervention (February-October 2019) and prospectively recruited postintervention (January-December 2020) cohorts. Consecutively admitted vascular surgery patients age ≥65 years at a tertiary academic hospital in Concord and with an expected length of stay (LOS) greater than 2 days were recruited. INTERVENTION: A comanagement model where a geriatrician was embedded within the vascular surgery team and delivered proactive comprehensive geriatric assessment based interventions. METHODS: Primary outcomes of incidence of hospital-acquired geriatric syndromes, delirium, and LOS were compared between groups using univariable and multivariable logistic regression analyses. Prespecified subgroup analysis was performed by frailty status. RESULTS: There were 150 patients in the preintervention group and 152 patients in the postintervention group. The postintervention group were more frail [66 (43.4%) vs 45 (30.0%)], urgently admitted [72 (47.4%) vs 56 (37.3%)], and nonoperatively managed [52 (34.2%) vs 33 (22.0%)]. These differences were attributed to the coronavirus disease 2019 pandemic during the postintervention phase. The postintervention group had fewer hospital-acquired geriatric syndromes [74 (48.7%) vs 97 (64.7%); P = .005] and reduced incident delirium [5 (3.3%) vs 15 (10.0%); P = .02], in unadjusted and adjusted analyses. Cardiac [8 (5.3%) vs 30 (20.0%); P < .001] and infective complications [4 (2.6%) vs 12 (8.0%); P = .04] were also fewer. LOS was unchanged. Frail patients in the postintervention group experienced significantly fewer geriatric syndromes including delirium. CONCLUSIONS AND IMPLICATIONS: This is the first prospective study of inpatient geriatric comanagement for older vascular surgery patients. Reductions in hospital-acquired geriatric syndromes including delirium, and cardiac and infective complications were observed after implementing geriatric comanagement. These benefits were also demonstrated in the frail subgroup.
OBJECTIVE: This study evaluates the impact of a novel model of care called Geriatric Comanagement of Older Vascular surgery inpatients on clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS: A pre-post study of geriatric comanagement, comparing prospectively recruited preintervention (February-October 2019) and prospectively recruited postintervention (January-December 2020) cohorts. Consecutively admitted vascular surgery patients age ≥65 years at a tertiary academic hospital in Concord and with an expected length of stay (LOS) greater than 2 days were recruited. INTERVENTION: A comanagement model where a geriatrician was embedded within the vascular surgery team and delivered proactive comprehensive geriatric assessment based interventions. METHODS: Primary outcomes of incidence of hospital-acquired geriatric syndromes, delirium, and LOS were compared between groups using univariable and multivariable logistic regression analyses. Prespecified subgroup analysis was performed by frailty status. RESULTS: There were 150 patients in the preintervention group and 152 patients in the postintervention group. The postintervention group were more frail [66 (43.4%) vs 45 (30.0%)], urgently admitted [72 (47.4%) vs 56 (37.3%)], and nonoperatively managed [52 (34.2%) vs 33 (22.0%)]. These differences were attributed to the coronavirus disease 2019 pandemic during the postintervention phase. The postintervention group had fewer hospital-acquired geriatric syndromes [74 (48.7%) vs 97 (64.7%); P = .005] and reduced incident delirium [5 (3.3%) vs 15 (10.0%); P = .02], in unadjusted and adjusted analyses. Cardiac [8 (5.3%) vs 30 (20.0%); P < .001] and infective complications [4 (2.6%) vs 12 (8.0%); P = .04] were also fewer. LOS was unchanged. Frail patients in the postintervention group experienced significantly fewer geriatric syndromes including delirium. CONCLUSIONS AND IMPLICATIONS: This is the first prospective study of inpatient geriatric comanagement for older vascular surgery patients. Reductions in hospital-acquired geriatric syndromes including delirium, and cardiac and infective complications were observed after implementing geriatric comanagement. These benefits were also demonstrated in the frail subgroup.
Authors: Anne L Meulenbroek; Miriam C Faes; Stefanie R van Mil; M G Buimer; Hans G W de Groot; Eelco J Veen; Gwan H Ho; Leandra J M Boonman-de Winter; Jolanda de Vries; Rebecca van Gorkom; Fleur Toonders; Rene van Alphen; Karolien van Overveld; Nathalie Verbogt; Ewout W Steyerberg; Lijckle van der Laan Journal: Clin Interv Aging Date: 2022-05-11 Impact factor: 3.829
Authors: Sarah J Aitken; Bernard Allard; Nishath Altaf; Noel Atkinson; Omar Aziz; Ruth Battersby; Ruth Benson; Jennifer L Chambers; Gabriella Charlton; Chloe Coleman; Joseph A Dawson; Anastasia Dean; Bedanta S Dhal; Robert Fitridge; John Gan; Joseph Hanna; Andrew T Hattam; Martin Hein; Kay Hon; Samantha Khoo; Joseph Kilby; Beatrice Kuang; Kai Wen Leong; Eunice Lim; Ju-Wei N Liu; David N McClure; Shreya Mehta; Jana-Lee Moss; Juanita Muller; Korana Musicki; Sandip Nandhra; Michael J Papanikolas; Fernando Picazo Pineda; Franklin Pond; Nandhini Ravintharan; Toby Richards; Hani Saeed; Christopher N Selvaraj; Gurkirat Singh; Yogeesan Sivakumaran; Bethany M Stavert; Elizabeth Suthers; Robert Tang; Vincent C Varley; Thodur M Vasudevan; Uyen G Vo; Timothy Wagner; Judy Wang; Jackie Wong Journal: ANZ J Surg Date: 2022-06-08 Impact factor: 2.025